(677) Atypical Hemolytic Uremic Syndrome and pregnancy outcomes: a cohort study

Atypical Hemolytic Uremic syndrome (AHUS) is a rare microangiopathy. As a dearth of information was available on the effect of this condition on pregnancy, our study aimed to examine the association between maternal AHUS and obstetrical and neonatal outcomes.

Study Design:

Using the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample from the US, a retrospective cohort study was conducted consisting of women who delivered between 1999-2015.  ICD-9 code 283.11 was used to identify women with a diagnosis of AHUS. Multivariate logistic regression estimated the effect of AHUS on maternal and neonatal outcomes, while adjusting for maternal baseline variables.

Results:

There were 13,792,429 women who delivered between 1999-2015, of which 115 had a diagnosis of AHUS (8/1,000,000). Women with AHUS, compared with those without this diagnosis, had greater prevalence of pre-existing diabetes, hypertension, and obesity. AHUS was associated with several adverse outcomes: maternal death, odds ratio 355.49, 95% CI 161.36-783.18, preeclampsia, 30.21 ,20.61-44.27, eclampsia, 10.68 ,1.49-76.68, placental abruptio, 16.77 ,10.22-27.52, disseminated intravascular coagulation, 260.53 ,134.30-505.40, venous thromboembolism, 18.82 ,7.60-46.59, sepsis, 134.81 ,48.73-372.96, myocardial infarction, 429.13 ,102.99-1788.15, post-partum hemorrhage, 19.16 ,13.09-28.04, requiring a blood transfusion, 121.43 ,83.25-177.12, and cesarean delivery, 3.93 ,2.63-5.86. Neonates born to women with AHUS were at increased risk for preterm birth, 3.89 ,2.53-5.97, intrauterine growth restriction, 3.64 ,1.83-7.25, and stillbirth, 13.66 ,7.29-25.59.

Conclusion:

There was a greater risk of adverse maternal and neonatal outcomes, including maternal and fetal death, among AHUS-impacted pregnancies; hence, such pregnancies should be attentively monitored.